Apparatus for endoscopic procedures

ABSTRACT

A surgical device has a jaw assembly with a first jaw and a second jaw, a pivoting linkage, and a camming assembly configured to pivot the jaw assembly. A cam slot having a first portion, a second portion, and a third portion may have a Y shaped configuration. A flexible shaft allows further pivoting of the jaw assembly.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 13/921,890, filed on Jun. 18, 2013, which is acontinuation-in-part of U.S. patent application Ser. No. 13/891,288,filed on May 10, 2013, which is a continuation-in-part of U.S. patentapplication Ser. No. 13/444,228, filed on Apr. 11, 2012, now U.S. Pat.No. 8,672,206, which is a continuation-in-part of U.S. patentapplication Ser. No. 13/280,898, filed on Oct. 25, 2011, now U.S. Pat.No. 8,899,462, which is a continuation-in-part of U.S. patentapplication Ser. No. 13/280,859, filed on Oct. 25, 2011, now U.S. Pat.No. 8,657,177, and also claims the benefit of and priority to U.S.Provisional Patent Application No. 61/779,873, filed on Mar. 13, 2013,and U.S. Provisional Patent Application 61/672,891, filed on Jul. 18,2012, and U.S. Provisional Patent Application No. 61/659,116, filed onJun. 13, 2012, the entire content of each of which is incorporatedherein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical apparatuses, devices and/orsystems for performing endoscopic surgical procedures and methods of usethereof. More specifically, the present disclosure relates toelectromechanical, hand-held surgical apparatus, devices and/or systemsconfigured for use with removable disposable loading units and/or singleuse loading units for clamping, cutting and/or stapling tissue.

2. Background of Related Art

Surgical devices for grasping or clamping tissue between opposed jawstructure of a tool assembly and thereafter fastening the clamped tissueare well known in the art. These devices may include a knife forincising the fastened tissue. The fasteners are typically in the form ofsurgical staples but two part fasteners formed of a material suitablefor surgical use are also well known.

Typically, the tool member includes a staple cartridge which houses aplurality of staples arranged in at least two laterally spaced rows andan anvil which includes a plurality of staple forming pockets forreceiving and forming staple legs of the staples as the staples aredriven from the cartridge. Generally, the stapling operation is effectedby cam bars that travel longitudinally through the staple cartridge,with the cam bars acting upon staple pushers to sequentially eject thestaples from the staple cartridge. A knife can travel between the staplerows to longitudinally cut and/or open the stapled tissue between therows of staples.

In laparoscopic and/or endoscopic surgical procedures, the surgicalprocedure is performed through a small incision or through a narrowcannula inserted through a small entrance wound in a patient. Because ofreduced patient trauma, shortened patient recovery periods andsubstantial reduction in overall cost, laparoscopic procedures arepreferred over open procedures. In order to address the specific needsof endoscopic and/or laparoscopic surgical procedures, endoscopicsurgical stapling devices have been developed which provide a surgeonwith easier access to the operative site. Typically, these staplingdevices include an articulatable tool member which is supported adjacentto the distal end of the stapling device. The tool member can beselectively manipulated to allow a surgeon to manipulate a tool assemblyin a confined space. There is a need for improved articulation and/orpivoting mechanisms that allow the surgeon to manipulate the tool memberin a variety of configurations.

SUMMARY

Further details and aspects of exemplary embodiments of the presentinvention are described in more detail below with reference to theappended Figures.

In an aspect of the present disclosure, a surgical device, comprises ajaw assembly including a first jaw and a second jaw moveable relative tothe first jaw. A pivoting linkage coupled to the proximal end of the jawassembly, the pivoting linkage comprising a distal joint member and aproximal joint member. The jaw assembly and the distal joint memberdefine a first longitudinal axis extending between a proximal end of thejaw assembly and a distal end of the distal joint member, and theproximal joint member defines a second longitudinal axis. The deviceincludes a camming assembly configured to pivot the jaw assemblyrelative to the proximal joint member about a pivot axis that isperpendicular to the first and second longitudinal axes.

The device can include a handle assembly and an elongated bodyconfigured to interconnect the handle assembly and the jaw assembly. Theelongated body can comprise a flexible shaft coupled to the proximal endof the proximal joint member and a rigid shaft portion coupled to theproximal end of the flexible shaft, wherein the rigid shaft portiondefines a third longitudinal axis and the flexible shaft is configuredto articulate the jaw assembly and the pivoting linkage relative to thethird longitudinal axis of the rigid shaft.

In certain embodiments, the distal joint member has a cam slot at theproximal end of the distal joint member and the device further comprisesa cam pin disposed in the cam slot. The cam slot can have a firstportion, a second portion, and a third portion; the first portion,second portion and third portion extending at an angle with respect toone another. In certain embodiments, the cam slot has a Y shapedconfiguration. The device can comprise a movable clevis having the campin.

In certain embodiments, the distal joint member comprises a pair ofopposing cam slots and the proximal joint member has a clevis associatedtherewith, the clevis having a pair of camming pins disposed within thepair of opposing cam slots such that movement of the clevis pivots thejaw assembly relative to the proximal joint member about the pivot axis.

The device can further comprise a drive screw disposed within the jawassembly; and a drive shaft disposed within the pivoting linkage, thedrive shaft configured to engage the drive screw and to rotate in afirst direction to move the second jaw relative to the first jaw.

In certain embodiments, the device further comprises a rotation linkdisposed within the proximal joint member, the rotation link defining alumen therethrough in which the drive shaft is disposed.

The pivoting linkage can further comprise a primary gearing assembly.The primary gearing assembly comprises a primary first gear coupled tothe jaw assembly configured to rotate the jaw assembly about the firstlongitudinal axis and a primary second gear coupled to the drive shaft.The pivoting linkage can include a secondary gearing assembly having asecondary first gear coupled to the primary first gear, the secondaryfirst gear configured to rotate the jaw assembly about the firstlongitudinal axis when the jaw assembly and the distal joint member arein a pivoted configuration, and a secondary second gear coupled to theprimary second gear, the secondary second gear configured to move thesecond jaw relative to the first jaw.

The rotation link can be movable in a distal direction by the clevis andis configured to engage the secondary first gear when the jaw assemblyand the distal joint member are in the pivoted configuration. In certainembodiments, the drive shaft is configured to engage the rotation linkwhen in a proximal position and to rotate in the first direction torotate the jaw assembly about the first longitudinal axis when the jawassembly and the distal joint member are in the pivoted configuration.

The drive shaft can be configured to engage the secondary second gear ina distal position and to rotate in the first direction to move thesecond jaw relative to the first jaw.

In a further aspect of the present disclosure, a surgical devicecomprises a jaw assembly having a first jaw and a second jaw moveablerelative to the first jaw, and a drive screw configured to move thesecond jaw relative to the first jaw. The device has a pivoting linkagecoupled to the proximal end of the jaw assembly, the pivoting linkagecomprising a distal joint member and a proximal joint member, whereinthe jaw assembly and the distal joint member define a first longitudinalaxis extending between a proximal end of the jaw assembly and a distalend of the distal joint member, and the proximal joint member defines asecond longitudinal axis. The device includes a camming assembly coupledto the distal and proximal joint members, the camming assemblyconfigured to pivot the jaw assembly relative to the proximal jointmember about a pivot axis that is perpendicular to the first and secondlongitudinal axes from an aligned configuration in which the first andsecond longitudinal axes are substantially parallel to each other into apivoted configuration in which the first and second longitudinal axesare substantially perpendicular to each other.

The device can include a drive shaft disposed within the pivotinglinkage, the drive shaft configured to engage the drive screw and torotate in a first direction to move the second jaw relative to the firstjaw when the jaw assembly is in one of the aligned configuration and thepivoted configuration. In certain embodiments, in the alignedconfiguration, the drive shaft is configured to engage the drive screwdirectly.

In certain embodiments, the pivoting linkage further comprises a primarygearing assembly having a primary first gear coupled to the jaw assemblyconfigured to rotate the jaw assembly about the first longitudinal axis.and a primary second gear coupled to the drive screw configured to movethe second jaw relative to the first jaw.

The pivoting linkage can have a secondary gearing assembly comprising asecondary first gear coupled to the primary first gear, the secondaryfirst gear configured to rotate the jaw assembly about the firstlongitudinal axis when the jaw assembly and the distal joint member arein a pivoted configuration, and a secondary second gear coupled to theprimary second gear, the secondary second gear configured to move thesecond jaw relative to the first jaw.

In certain embodiments, in the pivoted configuration, the drive shaft isconfigured to engage the drive screw through the secondary second gear.

In another aspect of the present disclosure, a surgical device comprisesa jaw assembly including a first jaw and a second jaw movable relativeto the first jaw, a pivoting linkage coupled to the proximal end of thejaw assembly, the pivoting linkage comprising a distal joint member anda proximal joint member, wherein the jaw assembly and the distal jointmember define a first longitudinal axis extending between a proximal endof the jaw assembly and a distal end of the distal joint member, and theproximal joint member defines a second longitudinal axis, the jawassembly being pivotable relative to the proximal joint member about apivot axis that is perpendicular to the first and second longitudinalaxis. The device includes a flexible shaft proximal of the pivotinglinkage, the flexible portion having a plurality of openingsaccommodating a plurality of cables for effectuating the flexing of theflexible portion.

The flexible shaft may include a plurality of segments, each segmenthaving a ball joint at a distal end thereof, and a proximal end defininga socket. The distal joint member may have a cam slot at the proximalend of the distal joint member and further comprising a cam pin disposedin the cam slot.

The cam slot may have a first portion, a second portion, and a thirdportion, the first portion, second portion and third portion extendingat an angle with respect to one another. The cam slot may have a Yshaped configuration. In certain embodiments, the device includes amovable clevis having the cam pin.

In certain embodiments, the distal joint member comprises a pair ofopposing cam slots and the proximal joint member has a clevis associatedtherewith, the clevis having a pair of camming pins disposed within thepair of opposing cam slots such that movement of the clevis pivots thejaw assembly relative to the proximal joint member about the pivot axis.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present disclosure are described herein withreference to the accompanying drawings, wherein:

FIG. 1 is a perspective view of an electromechanical surgical systemaccording to the present disclosure;

FIG. 2 is a disassembled, perspective view of a surgical instrument, anelongated member, and an end effector of the electrosurgical surgicalsystem of FIG. 1, according to the present disclosure;

FIG. 3 is a side, cross-sectional view of the surgical instrument ofFIG. 1, as taken through 3-3 of FIG. 1, according to the presentdisclosure;

FIG. 4 is a top, cross-sectional view of the surgical instrument of FIG.1, as taken through 4-4 of FIG. 1, according to the present disclosure;

FIG. 5 is a front, perspective view of the surgical instrument of FIG. 1with the elongated member of FIG. 2 separated therefrom, according tothe present disclosure;

FIG. 6 is a front, perspective view of the elongated member and the endeffector of FIG. 1 in articulated and pivoted configurations accordingto the present disclosure;

FIG. 7 is a side, cross-sectional view of the end effector of FIG. 1,according to the present disclosure;

FIG. 8 is an enlarged, side, cross-sectional view of the end effector ofFIG. 1, according to the present disclosure;

FIG. 9 is an enlarged, perspective, rear view of the end effector ofFIG. 1, according to the present disclosure;

FIG. 10 is a side, partially-exploded view of a drive coupling assemblyaccording to the present disclosure;

FIG. 11 is an exploded, perspective view of the end effector of FIG. 1,according to the present disclosure;

FIG. 12 is a side, cross-sectional view of the end effector of FIG. 1,according to the present disclosure;

FIG. 13 is a perspective, bottom view of a pivoting linkage of the endeffector of FIG. 1, according to the present disclosure;

FIG. 14 is a perspective, top view of the pivoting linkage of FIG. 13,according to the present disclosure;

FIG. 15 is an exploded, perspective view of the pivoting linkage of FIG.13, according to the present disclosure;

FIG. 16 is a perspective, cross-sectional view of the pivoting linkageof FIG. 13 in an aligned configuration with a drive shaft disengaged anaccording to the present disclosure;

FIG. 17 is a perspective, cross-sectional view of the pivoting linkageof FIG. 13 in the aligned configuration with the drive shaft engaged anaccording to the present disclosure;

FIG. 18 is a perspective, cross-sectional view of the pivoting linkageof FIG. 13 in a pivoted configuration with the drive shaft disengaged anaccording to the present disclosure;

FIG. 19 is a perspective, cross-sectional view of the pivoting linkageof FIG. 13 in the pivoted configuration with the drive shaft engaged anaccording to the present disclosure;

FIG. 20 is a side, partially-exploded view of the pivoting linkage ofFIG. 13 in the aligned configuration according to the presentdisclosure;

FIG. 21 is a side view of the pivoting linkage of FIG. 13 transitioningfrom the aligned configuration to the pivoted configuration with acamming pin engaging a second portion of a cam slot according to thepresent disclosure;

FIG. 22 is a side view of the pivoting linkage of FIG. 13 transitioningfrom the aligned configuration to the pivoted configuration with thecamming pin engaged in the second portion of the cam slot according tothe present disclosure;

FIG. 23 is a side view of the pivoting linkage of FIG. 13 transitioningfrom the aligned configuration to the pivoted configuration with thecamming pin engaging a third portion of the cam slot according to thepresent disclosure; and

FIG. 24 is a side view of the pivoting linkage of FIG. 13 in the pivotedconfiguration with the camming pin engaged in the third portion of thecam slot according to the present disclosure.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of the presently disclosed electromechanical surgicalsystem, apparatus and/or device are described in detail with referenceto the drawings, in which like reference numerals designate identical orcorresponding elements in each of the several views. As used herein theterm “distal” refers to that portion of the electromechanical surgicalsystem, apparatus and/or device, or component thereof, that are fartherfrom the user, while the term “proximal” refers to that portion of theelectromechanical surgical system, apparatus and/or device, or componentthereof, that are closer to the user. The terms “left” and “right” referto that portion of the electromechanical surgical system, apparatusand/or device, or component thereof, that are on the left (e.g., port)and right (e.g., starboard) sides, respectively, from the perspective ofthe user facing the distal end of the electromechanical surgical system,apparatus and/or device from the proximal end while the surgical system,apparatus and/or device is oriented in non-rotational configuration.

Referring initially to FIGS. 1-5, an electromechanical, hand-held,powered surgical system, in accordance with an embodiment of the presentdisclosure is shown and generally designated 10. Electromechanicalsurgical system 10 includes a surgical apparatus or device in the formof an electromechanical, hand-held, powered surgical instrument 100 thatis configured for selective attachment thereto of a plurality ofdifferent end effectors 400, via a shaft assembly 200. The end effector400 and the shaft assembly 200 are configured for actuation andmanipulation by the electromechanical, hand-held, powered surgicalinstrument 100. In particular, the surgical instrument 100, the shaftassembly 200, and the end effector 400 are separable from each othersuch that the surgical instrument 100 is configured for selectiveconnection with shaft assembly 200, and, in turn, shaft assembly 200 isconfigured for selective connection with any one of a plurality ofdifferent end effectors 400.

Reference may be made to International Application No.PCT/US2008/077249, filed Sep. 22, 2008 (Inter. Pub. No. WO 2009/039506)and U.S. patent application Ser. No. 12/622,827, filed on Nov. 20, 2009,the entire content of each of which is incorporated herein by reference,for a detailed description of the construction and operation ofexemplary electromechanical, hand-held, powered surgical instrument 100.

Generally, as illustrated in FIGS. 1-4, surgical instrument 100 includesa handle housing 102 having a lower housing portion 104, an intermediatehousing portion 106 extending from and/or supported on lower housingportion 104, and an upper housing portion 108 extending from and/orsupported on intermediate housing portion 106. Intermediate housingportion 106 and upper housing portion 108 are separated into a distalhalf-section 110 a that is integrally formed with and extending from thelower portion 104, and a proximal half-section 110 b connectable todistal half-section 110 a by a plurality of fasteners (FIGS. 3 and 4).When joined, distal and proximal half-sections 110 a, 110 b define thehandle housing 102 having a cavity 102 a therein in which a controlassembly 150 and a drive mechanism 160 are disposed. The instrument 100also includes a power source (not shown), which is coupled to thecontrol assembly 150 and the drive mechanism 160. Control assembly 150may include one or more logic controllers and/or user interfaces (e.g.,switches, buttons, triggers, touch screens, etc.) and is configured tocontrol the various operations of the instrument 100, in particular, thedrive mechanism 160, as discussed in further detail below.

Lower housing portion 104 of the instrument 100 defines an aperture (notshown) formed in an upper surface thereof and which is located beneathor within intermediate housing portion 106. The aperture of lowerhousing portion 104 provides a passage through which wires and othervarious electrical leads interconnect electrical components (e.g., powersource and any corresponding power control circuitry) situated in lowerhousing portion 104 with electrical components (e.g., control assembly150, drive mechanism 160, etc.) situated in intermediate housing portion106 and/or upper housing portion 108.

With reference to FIGS. 3 and 4, distal half-section 110 a of upperhousing portion 108 defines a nose or connecting portion 108 a. A nosecone 114 is supported on nose portion 108 a of upper housing portion108. Upper housing portion 108 of handle housing 102 provides a housingin which drive mechanism 160 is disposed. The drive mechanism 160 isconfigured to drive shafts and/or gear components in order to performthe various operations of instrument 100. In particular, drive mechanism160 is configured to drive shafts and/or gear components in order toselectively rotate the end effector 400 about a longitudinal axis A-Adefined by the a rigid portion 204 of the shaft assembly 200 (FIG. 6)relative to the handle housing 102, to move jaw members of the endeffector 400 relative to each other, and/or to fire the fasteners, tocut the tissue grasped within the end effector 400.

As seen in FIGS. 3 and 4, drive mechanism 160 includes a selectorgearbox assembly 162 that is located immediately proximal relative to ashaft assembly 200. Proximal to the selector gearbox assembly 162 is afunction selection module 163 having a first motor 164 that functions toselectively move gear elements within the selector gearbox assembly 162into engagement with an input drive component 165 having a second motor166. With particular reference to FIG. 5, the distal half-section 110 aof upper housing portion 108 defines a connecting portion 108 aconfigured to accept a corresponding drive coupling assembly 210 of theshaft assembly 200.

With continued reference to FIG. 5, the connecting portion 108 a ofinstrument 100 includes a cylindrical recess 108 b that receives thedrive coupling assembly 210 of shaft assembly 200. Connecting portion108 a houses three rotatable drive connectors 118, 120, 122. When shaftassembly 200 is mated to instrument 100, each of rotatable driveconnectors, namely, first drive connector 118, second drive connector120, and third drive connector 122 of instrument 100, mechanicallyengage a corresponding rotatable connector sleeve, namely, firstconnector sleeve 218, second connector sleeve 220, and third connectorsleeve 222 of shaft assembly 200.

The mating of drive connectors 118, 120, 222 of instrument 100 withconnector sleeves 218, 220, 222 of shaft assembly 200 allows rotationalforces to be independently transmitted via each of the three respectiveconnector interfaces. The drive connectors 118, 120, 122 of instrument100 are configured to be independently rotated by drive mechanism 160.In this regard, the function selection module 163 of drive mechanism 160selects which drive connector or connectors 118, 120, 122 of instrument100 is to be driven by the input drive component 165 of drive mechanism160.

With continued reference to FIGS. 3 and 4, drive mechanism 160 includesa selector gearbox assembly 162 and a function selection module 163,located proximal to the selector gearbox assembly 162 that functions toselectively move gear elements within the selector gearbox assembly 162into engagement with second motor 166. Thus, drive mechanism 160selectively drives one or more of drive connectors 118, 120, 122 ofinstrument 100 at a given time.

Since each of drive connectors 118, 120, 122 of instrument 100 has akeyed and/or substantially non-rotatable interface with respectiveconnector sleeves 218, 220, 222 of shaft assembly 200, when shaftassembly 200 is coupled to instrument 100, rotational force(s) areselectively transferred from drive mechanism 160 of instrument 100 toshaft assembly 200.

The selective rotation of drive connector(s) 118, 120 and/or 122 ofinstrument 100 allows instrument 100 to selectively actuate differentfunctions of the end effector 400. In embodiments, any number of thedrive connectors 118, 120, and/or 122 may be used to operate the endeffector 400. As will be discussed in greater detail below, selectiveand independent rotation of first drive connector 118 of instrument 100corresponds to the selective and independent opening and closing of thejaw members of the end effector 400, and driving of the actuation sled440 (FIG. 8) of end effector 400. The selective and independent rotationof the third drive connectors 120, 122 of instrument 100 corresponds tothe selective and independent pivoting of the end effector 400 relativeto the shaft assembly 200.

FIG. 6 shows the shaft assembly 200 and the end effector 400. The shaftassembly 200 includes rigid portion 204 at its proximal endinterconnecting drive coupling assembly 210 and a flexible portion orflexible shaft 202. The shaft assembly 200 also includes a pivotinglinkage 500 interconnecting the flexible portion 202 and the endeffector 400. As shown in FIGS. 7 and 8, the rigid portion 204 housesthe first connector sleeve 218, which is coupled to a flexible driveshaft 119 extending through flexible shaft 202. The shaft 119 may beformed from any suitable flexible and torsionally stiff material thatmay be articulated along with the flexible shaft 202 to allow for thearticulation of the end effector 400 relative to the rigid portion 204between a non-articulated position in which a longitudinal axis B-Bdefined by the end effector 400 is substantially aligned with axis A-Adefined by the rigid portion 204; and an articulated position in whichthe longitudinal axis of end effector 400 is disposed at a substantiallynon-zero angle relative to the axis A-A of the rigid portion 204. Shaft119 may be fabricated from stainless steel or the like.

As seen in FIG. 8, the flexible shaft 202 includes a plurality ofinterlocking segments 206 each defining an opening 206 a therethrough.The shaft 119 is disposed within the openings 206 a as shown in FIG. 8.Each of the interlocking segments 206 includes a socket 206 b at itsproximal end and a ball joint 206 c at its distal end. The ball joint206 c of one segment 206 is configured and dimensioned to interface withthe socket 206 b of the distal neighboring segment 206 allowing theentire flexible shaft 202 to flex and thereby articulate in any desireddirection through 360° around a longitudinal axis of rigid portion 204.In particular, articulation of the flexible shaft 202 allows forarticulation of the end effector 400 and pivoting linkage 500 withrespect to the axis A-A.

With reference to FIGS. 9 and 10, articulation of the flexible portion202 may be accomplished by tensioning cables 205 a, 205 b, 205 c, 205 d.In embodiments, four equally radially-spaced apart cables may be used,which are coupled to the end effector 400 and which pass through theflexible shaft 202. In particular, as shown in FIGS. 9 and 10, each ofthe cables 205 a, 205 b, 205 c, 205 d may be disposed within arespective opening 206 d of the segments 206. Thus, tension applied toone or more of cables would adjust a direction of articulation of theflexible shaft 202. A cable articulation instrument is disclosed in acommonly-owned U.S. Provisional Patent Application No. 61/510,091, filedon Jul. 21, 2011, entitled “Articulating Links With Middle Link ControlSystem”, the entire contents of which are incorporated by referenceherein.

With reference to FIG. 10, the drive coupling assembly 210 is shownhaving each of the cables 205 a, 205 b, 205 c, 205 d coupled to anchorbars 207 a, 207 b, 207 c, 207 d, respectively. The cables 205 a, 205 b,205 c, 205 d may be secured to the bars 207 a, 207 b, 207 c, 207 d byany suitable means including, but not limited to, adhesive, knots, etc.The bars 207 a, 207 b, 207 c, 207 d are coupled to an attachment ring209 in an equally radially-spaced apart configuration to maintain radialalignment of the cables 205 a, 205 b, 205 c, 205 d. The bars 207 a, 207b, 207 c are fixedly coupled to the ring 209 whereas the bar 207 d isslidingly coupled thereto such that the bar 207 d can movelongitudinally relative to the ring 209. The bar 207 d includes a detent211 that is disposed within a slot 215 of a cylinder 213. The slot 215is defined diagonally through the cylinder 213 with respect the axisA-A.

The ring 209 may be threadably coupled to one or more threaded driveshafts 220 a and 222 a. As the drive shafts 220 a and 222 a are rotated,the ring 209 travels in a longitudinal direction along the longitudinalaxis defined by the drive shafts 220 a and 222 a. Rotation of the driveshafts 220 a and 222 a is imparted through the connection sleeves 220and 222 as described above. As the ring 209 travels distally in alongitudinal direction, the bars 207 a, 207 b, 207 c are moved distallyas well, thereby tensioning cables 205 a, 205 b, 205 c.

The cable 205 d is tensioned independently of the cables 205 a, 205 b,205 c, allowing the end effector 400 to be articulated through theflexible shaft 202 with respect to the longitudinal axis A-A.Specifically, as the tension that is applied on the cable 205 d ishigher than that applied on the cables 205 a, 205 b, 205 c, the flexibleshaft 202 is bent in the direction of the cable 205 d. Differentialtension on the cable 205 d is applied via the bar 207 d which isactuated by the cylinder 213. As cylinder 213 is rotated about thelongitudinal axis A-A, longitudinal movement is imparted to the bar 207d due to the engagement of the detent 211 of bar 207 d and the slot 215of cylinder 213. In particular, as the cylinder 213 is rotated in aclockwise direction about the axis A-A the bar 207 d is moved proximallythereby increasing tension on the cable 207 d. Conversely, as thecylinder 213 is rotated in a counterclockwise direction, the bar 207 dis moved distally thereby loosening tension on the cable 207 d.

FIGS. 11 and 12 illustrate components and operation of the end effector400. End effector 400 includes a pair of jaw members, which include acartridge assembly 432 and an anvil 434. Cartridge assembly 432 housesone or more fasteners 433 (FIG. 11) that are disposed therewithin and isconfigured to deploy the fasteners 433 upon firing of instrument 100.The anvil 434 is movably (e.g., pivotally) mounted to the end effector400 and is movable between an open position, spaced apart from cartridgeassembly 432, and a closed position wherein anvil 434 is in closecooperative alignment with cartridge assembly 432, to thereby clamptissue.

Referring to FIG. 11, an exploded view of the end effector 400 is shown.The end effector 400 also includes a carrier 431 having an elongatechannel 411, a base 412 and two parallel upstanding walls 414 and 416which include several mounting structures, such as notches 439, forsupporting the cartridge assembly 432 and the anvil 434. A longitudinalslot 413 extends through the elongate channel 411.

The carrier 431 also includes a plate cover 415 disposed on a bottomsurface thereof. The plate cover 415 is configured to frictionallyengage with channel 411 of the carrier 431 and functions to protecttissue from moving parts along the exterior of carrier 431. The carrier431 also includes a pair of tabs 407 and 409 disposed at a proximal endof respective walls 414, 416, and being configures for coupling to ahousing member 410 of end effector 400.

With continuing reference to FIG. 11, the distal portion of channel 411supports the cartridge assembly 432 which contains the plurality ofsurgical fasteners 433 and a plurality of corresponding ejectors orpushers 437. End effector 400 includes an actuation sled 440 havingupstanding cam wedges 444 configured to exert a fastener driving forceon the pushers 437, which drive the fasteners 433 from cartridgeassembly 432, as described in more detail below. Cartridge assembly 432is maintained within channel 411 by lateral struts 436 whichfrictionally engage corresponding notches 439 formed in the uppersurfaces of channel walls 414 and 416. These structures serve torestrict lateral, longitudinal, and elevational movement of thecartridge assembly 432 within channel 411.

A plurality of spaced apart longitudinal slots (not shown) extendthrough cartridge assembly 432 and accommodate the upstanding cam wedges444 of actuation sled 440. The slots communicate with a plurality ofpockets within which the plurality of fasteners 433 and pushers 437 arerespectively supported. The pushers 437 are secured by a pusher retainer(not shown) disposed below the cartridge assembly 432, which supportsand aligns the pushers 437 prior to engagement thereof by the actuationsled 440. During operation, as actuation sled 440 translates throughcartridge assembly 432, the angled leading edges of cam wedges 444sequentially contact pushers 437 causing the pushers to translatevertically within slots 446, urging the fasteners 434 therefrom. Thecartridge assembly 432 also includes a longitudinal slot 485 to allowfor a knife blade 474 to travel therethrough, as described in moredetail below.

With continuing reference to FIG. 11, the end effector 400 includes ananvil cover 435 disposed over the anvil 434. The anvil cover 435protects tissue from moving parts along the exterior of anvil 434. Theanvil cover 435 includes opposed mounting wings 450 and 452 which aredimensioned and configured to engage detents 454 and 456 of the anvil434, respectively. The mounting wings 450 and 452 function to align theanvil 434 with the cartridge assembly 432 during closure. The anvil 434and the cover 435 are configured to remain in an open configurationuntil closed, as described in more detail below.

The anvil 434 is pivotally coupled to the carrier 431. The carrier 431includes a pair of openings 421 and 422 formed in respective tabs 407,409. The anvil cover 435 also includes a pair of opposed openings 457and 459 found therein. A pivot pin 417, or a pair of pins, passesthrough the openings 421, 422, 457, and 459 allowing for pivotalcoupling of the anvil 434 to the carrier 431.

As seen in FIG. 11, end effector 400 further includes an axial drivescrew 460 for transmitting the rotational drive forces exerted by theflexible drive shaft 119 to actuation sled 440 during a staplingprocedure. Drive screw 460 is rotatably supported in carrier 431 andincludes a threaded portion 460 a and a proximal end 461. The drivescrew 460 is rotatably secured at a distal end of the cartridge 432 andincludes one or more bearings 466 frictionally fitted about the proximalend 461. This allows the drive screw 460 to be rotated relative to thecarrier 431. Proximal housing member 410 of the effector 400 is coupledto the proximal end of the carrier 431 via one or more bolts 412 and aspacer 410 a. The housing member 410 includes a bore 414 definedtherethrough that houses the proximal end 461 therein.

With confirmed reference to FIGS. 11 and 12, end effector 400 furtherincludes a drive beam 462 disposed within carrier 431. The drive beam462 includes a vertical support strut 472 and an abutment surface 476which engages the central support wedge 445 of actuation sled 440. Thedrive beam 462 also includes a cam member 480 disposed on top of thevertical support strut 472. Cam member 480 is dimensioned and configuredto engage and translate with respect to an exterior camming surface 482of anvil 434 to progressively clamp the anvil 434 against body tissueduring firing.

A longitudinal slot 484 extends through the anvil 434 to accommodate thetranslation of the vertical strut 472. This allows the cam member 480 totravel in between the cover 435 and anvil 434 during firing. Inembodiments, the anvil cover 435 may also include a correspondinglongitudinal slot (not shown) formed on an underside thereof and issecured to an upper surface of anvil 434 to form a channel therebetween.

The drive beam 462 includes a distal retention foot 488 a and a proximalretention foot 488 b, each having a bore 489 a and 489 b definedtherethrough. The bores 489 a and 489 b may be either threaded or smoothto provide for travel along the drive screw 460 which passestherethrough. A travel nut 490 having a threaded bore 490 a therethroughis disposed between the distal and proximal retention feet 488 a and 488b. The drive screw 460 is threadably coupled to the travel nut 490through the bore 490 a, such that as the drive screw 460 is rotated, thetravel nut 490 travels in a longitudinal direction along thelongitudinal axis defined by the drive screw 460 and also engaging thefeet 488 a and 488 b.

In use, as the drive screw 460 is rotated in a clock-wise direction, thetravel nut 490 and the drive beam 462 travel in a distal directionclosing the anvil 434 as the cam member 480 pushes down on the cammingsurface 482 thereof. The drive beam 462 also pushes the sled 440 in thedistal direction, which then engages the pushers 437 via the cam wedges444 to eject the fasteners 433. The drive beam 462 may be made of anysuitable first material including, but not limited to, plastics, metals,and combinations thereof. The travel nut 490 may be made of any suitablesecond material also including, but not limited to, plastics, metals,and combinations thereof. The first and second materials may be eithersame or different. In embodiments, the drive beam 462 may include asingle retention foot with a threaded bore defined therethrough, whichis threadably coupled to the drive screw 460.

With reference to FIG. 11, the drive beam 462 also includes a knifeblade 474 for dissecting the fastened tissue. The knife blade 474travels slightly behind actuation sled 440 during a stapling procedureto form an incision between the rows of fastener. As the drive beam 462is driven in the distal direction, the abutment surface 4 7 6 of thevertical strut 4 72 pushes the sled 440 in the distal direction to ejectthe fasteners 433 and simultaneously dissect tissue with the knife blade474. The knife blade 474 and the drive beam 462 travel through thelongitudinal slots 484 and 485. The drive beam 462 closes the anvil asit is driven in the distal direction and also pushes the sled 440,which, in turn, ejects the fasteners 433 ahead of the knife blade 474.As the fasteners 433 are ejected they are deformed again thetissue-contacting (e.g., underside) surface of the anvil 434 having aplurality of anvil pockets (not shown).

With respect to FIGS. 13-16, the pivoting linkage 500 includes a rigidproximal joint member 502 and a rigid distal joint member 504 coupled tothe end effector 400. The proximal and distal members 502 and 504 arepivotally coupled to each other. Referring to FIG. 15, an exploded viewof the pivoting linkage 500 is shown. The proximal joint member 502 alsoincludes two parallel upstanding walls 514 and 516 defining an elongatechannel 511 at its distal end that transitions into a longitudinal lumen512 at its proximal end. Each of the walls 514 and 516 includes anelongate slot 514 a and 516 a defined therein and an opening 514 b and516 b, respectively. The proximal joint member 502 also includes anchorpoints 518 a, 518 b, 518 c, 518 d disposed at a proximal end thereof.The anchor points 518 a, 518 b, 518 c, 518 d are coupled to the distalends of the cables 205 a, 205 b, 205 c, 205 d thereby securing thesegments 206 of the flexible shaft 202 between the proximal joint member502 and the rigid portion 204.

The distal joint member 504 includes a longitudinal lumen 520 definedtherethrough that connects to a transverse lumen 522 that is transverseto the longitudinal lumen 520. The distal joint member 504 may include apair of opposing walls 523 and 525 configured to fit between the walls514 and 516 of the proximal joint member 502. The distal joint member504 has at least one cam slot defined in the walls 523 and 525 at aproximal end of the distal joint member. For example, cam slots 524 and526 are defined within the walls 523 and 525 at a proximal end of thedistal joint member 504. The distal joint member 504 further includes apair of openings 523 a and 525 a defined through the distal joint member504. A pair of mechanical fasteners, such as pins, rivets, and the like,pass through each the openings 523 a, 525 a of the distal joint member504 and corresponding openings 514 b and 516 b of the proximal jointmember 502 allowing for pivotal coupling of the distal joint member 504to the proximal joint member 502 (e.g., via rivets, stamping, crimping,etc.).

With continuing reference to FIGS. 15 and 16, the housing member 410further includes an outer rotational engagement portion 411. The outerrotational engagement portion 411 has a substantially cylindrical shapedefining a longitudinal lumen 413 therethrough. The engagement portion411 also includes an inner rotational engagement portion 415 disposed ata proximal end thereof and within the lumen 413. Similarly to theengagement portion 411, the engagement portion 415 has a substantiallycylindrical shape defining a longitudinal lumen 417 therethrough. Theproximal end 461 of the drive screw 460 extends through the housingmember 410 such that the proximal end 461 of the drive screw 460 extendsthrough the lumens 413 and 415 of the outer rotational engagementportion 411 and inner rotational engagement portion 415, respectively,as well as the lumen 520 of the distal joint member 504. The proximalend 461 of the drive screw 460 includes a female opening 461 a having acomplementary mating surface configured and dimensioned to mechanicallyinterface with a drive shaft 530 as described in further detail below.

The engagement portion 415 of the housing member 410 is fixedly coupledto the proximal end 461 of the drive screw 460 and includes a pair ofopenings 415 a, 415 b defined in the cylindrical walls thereof. Thedrive screw 460 includes a proximal transverse lumen 461 b therethrough.The proximal transverse lumen 461 b is aligned with the openings 415 a,415 b of the engagement portion 415 such that a pin 528 is frictionallyfitted therethrough thereby securing the drive screw 460 to theengagement portion 415. In embodiments, the engagement portion 415 maybe secured to the proximal end 461 of the drive screw 460 using anysuitable methods, such as, mechanical fasteners, adhesives, and thelike. In further embodiments, the engagement portion 415 may be formedintegrally with the drive screw 460. The inner rotational engagementportion 415 may freely rotate within the outer rotational engagementportion 411. This configuration allows the drive screw 460 along withthe engagement portion 415 to be rotated relative to the outerrotational engagement portion 411 and relative to the housing member410.

The end effector 400 includes a primary gearing assembly 419. Thegearing assembly 419 includes a first gear 419 a and a second gear 419 bdefined at proximal ends of the engagement portions 411 and 415,respectively. The gears 419 a and 419 b are configured and dimensionedas miter or bevel gears and may be formed by chamfering the proximaledges of the engagement portions 411 and 415, respectively.

As described in further detail below, engagement of the gear 419 aallows for rotation of the engagement portion 411 along with the housingmember 410 and the end effector 400 about the longitudinal axis B-Brelative to the pivoting linkage 500. Additionally, engagement of thegear 419 b allows for rotation of the engagement portion 415 along withthe drive screw 460 to close the anvil 434, eject the fasteners 433,and/or cut tissue as described above.

In embodiments, the end effector 400 may be removably coupled to thepivoting linkage 500. As shown in FIGS. 15 and 16, the distal jointmember 504 includes a latch assembly 530 that is adapted to engage agroove 411 b on the surface of outer rotational engagement portion 411.The latch assembly 530 includes a lever 532 pivotally coupled via a pin533 to the outer surface of the distal joint member 504. The lever 532includes a knob 534 configured and dimensioned for engaging the groove411 b of outer rotational engagement portion 411 and a cavity 536 forhousing a spring 538, which biases the lever 532, and in turn, the knob534 into engagement with the groove 411 b of the outer rotationalengagement portion 411. The groove 411 b extends along the entire outercircumference of the outer rotational engagement portion 411, such thatwhen the knob 534 is disposed within the groove 411 b, the end effector400 is secured to the pivoting linkage 500 while still allowing forrotation of the end effector 400 relative to the pivoting linkage 500.During insertion and/or ejection of the end effector 400 from thepivoting linkage 500, the lever 532 is depressed to pull the knob 534from engagement with the groove 411 b of the outer rotational engagementportion 411.

With continuing reference to FIGS. 15 and 16, the distal joint member504 also includes secondary outer and secondary inner engagement members550 and 552, respectively. The secondary outer engagement member 550 isrotationally disposed within the lumen 522 of the distal joint member504. The secondary outer engagement member 550 defines a lumen 550 atherethrough and the secondary inner engagement member 552 is configuredand dimensioned to rotate therein. A bushing 556 is disposed about theouter circumference of the secondary inner engagement member 552 actingas a buffer between the engagement members 550 and 552 allowing forrotation of the secondary outer and secondary inner engagement members550 and 552 relative to each other and relative to the distal jointmember 504.

With respect to FIG. 16, the secondary outer engagement member 550includes a mating surface 550 b configured and dimensioned tomechanically interface with a rotation link 564 as described in furtherdetail below. The secondary inner engagement member 552 also includes amating surface 552 a configured and dimensioned to mechanicallyinterface with the drive shaft 530 as described in further detail below.

With continuing reference to FIGS. 15 and 16, the distal joint member504 also includes a secondary gearing assembly 540. The secondarygearing assembly 540 includes a first gear 540 a and a second gear 540b. The first gear 540 a and the second gear 540 b are configured anddimensioned as miter or bevel gears for engaging the first gear 419 aand the second gear 419 b, respectively. The gears 540 a and 540 b aredisposed on the opposite ends from the mating surfaces 550 a and 552 aof the secondary outer and secondary inner engagement members 550 and552, respectively.

As shown in FIG. 16, the proximal end of the engagement portion 415 ofhousing member 410 is disposed proximally of the proximal end of theouter rotational engagement portion 411, such that the internallydisposed second gear 419 b extends outside the first gear 419 a.Similarly, the internally disposed gear 540 b of the secondary innerengagement member 552 extends past the gear 540 a of the secondary outerengagement member 550. The secondary outer and secondary innerengagement members 550 and 552 are secured within the lumen 522 of thedistal joint member 504 by one or more washers 553. In particular thewashers 553 abut the secondary outer engagement member 550, which inturn, abuts the secondary inner engagement member 552 therebyinterlocking the first gear 540 a and the second gear 540 b with thefirst gear 419 a and the second gear 419 b, respectively.

With continued reference to FIGS. 15 and 16, the proximal joint member502 includes a push rod 560 disposed within the lumen 512 of jointmember 502. The push rod 560 is configured to slidingly move within thelumen 512 of joint member 502 and is configured and dimensioned toengage the most distal segment 206 of joint member 502. In embodiments,the distal segment 206 of joint member 502 may include a cavityconfigured and dimensioned to engage the proximal end of the push rod560 as shown in FIGS. 18 and 19. The push rod 560 is moved in the distaldirection by tensioning cables 205 a, 205 b, 205 c, 205 d to approximatethe pivoting linkage 500 to the distal segment 206, which in turn,advances the push rod 560 into the lumen 512 of joint member 502.

The push rod 560 defines a longitudinal lumen 561 to allow for passageof the drive shaft 119 therethrough. The lumen 561 of push rod 560 alsoincludes a distal portion 561 a and a proximal portion 561 b. The driveshaft 530 is coupled to the flexible drive shaft 119 within the lumen561 of push rod 560. In particular, the drive shaft 119 is disposedwithin the proximal portion 561 b of the lumen 561 of push rod 560 andthe drive shaft 530 is disposed within the distal portion 561 a of lumen561 establishing a coupling therebetween.

The distal portion 561 a of the lumen 561 has a larger diameter than theproximal portion 561 b and is sufficient to accommodate a spring 562disposed over the drive shaft 530. The spring 562 is biased between thepush rod 560 and a rotation link 564. The rotation link 564 has asubstantially cylindrical shape and defines a longitudinal lumen 566 toallow for passage of the drive shaft 530 therethrough. Similarly to thepush rod 560, the rotation link 564 is also configured to slidingly movewithin the lumen 512 as well as to rotate therein. The lumen 566 ofrotation link 564 also includes a distal portion 566 a and a proximalportion 566 b. The distal and proximal portions 566 a and 566 b of lumen566 include a ridge 568 therebetween which provides a seat for thespring 562. The rotation link 564 also includes a gear 569 at its distalend that is configured and dimensioned to mechanically interface withthe mating surface 550 b of the engagement member 550.

The drive shaft 530 is disposed within the lumen 566 of rotation link564 and is configured to slidingly move and/or to rotate therein. Thedrive shaft 530 is also disposed within the spring 562, withoutcontacting the spring 562, allowing the drive shaft 530 to moveindependently inside thereof. The distal end of the drive shaft 119 andthe proximal end of the drive shaft 530 include complementary matingsurfaces, such that rotation and longitudinal movement of the driveshaft 119 is transferred to the drive shaft 530.

The drive shaft 530 also includes an intermediate portion 570 thatprovides a complementary mating surface to the ridge 568. This allowsfor transfer of rotational motion of the drive shaft 530 to the rotationlink 564. The intermediate portion 570 of drive shaft 530 also includesa bushing 572, which is disposed about the outer circumference of theengagement intermediate portion 570 acting as a buffer between the driveshaft 530 and the inner walls of the rotation link 564 allowing forrotation of the drive shaft 530 within the rotation link 564 when theintermediate portion 570 of drive shaft 530 and the ridge 568 ofrotation link 564 are disengaged. The bushing 572 also acts as a stopmember, preventing proximal movement of the drive shaft 530 relative tothe rotation link 564 since bushing 572 is configured and dimensioned tocome in contact with the ridge 568 of rotation link 564 as the driveshaft 530 is moved in the proximal direction.

There is a camming mechanism associated with the pivoting linkage. Withreference to FIGS. 14-16, a substantially U-shaped clevis 580 isassociated with the proximal joint member 502. The clevis 580 has firstand second longitudinal arms 582 and 584 extending distally from anopening 586. The clevis 580 is disposed within the lumen 512 of proximaljoint member 502. In embodiments, the arms 582 and 584 may extendoutside the proximal joint member 502 as shown in FIGS. 13 and 14. TheU-shaped structure of the clevis 580 along with the opening 586 allowsfor longitudinal travel of the drive shaft 530 therethrough.

Each of the longitudinal arms 582 and 584 includes a camming pin 582 aand 584 a at distal ends thereof. The camming pins 5 82 and 5 84 aredisposed within the slots 514 a and 516 a, respectively, of the proximaljoint member 502. The clevis 580 is moved distally by the push rod 560as it is engaged by the distal segment 206. The slots 514 a and 516 a ofproximal joint member 502 maintain the travel of the clevis 580 alongthe longitudinal axis B-B.

The camming pins 582 a and 584 a are also disposed within the cam slots524 and 526 of distal joint member 504 as shown in FIGS. 15 and 18,respectively. Each of the cam slots 524 and 526 of distal joint member504 includes a first portion 524 a, 526 a, a second portion 524 b, 526b, and a third portion 524 c, 526 c, respectively. For simplicity, onlythe cam slot 526 and first, second, and third portions 526 a, 526 b, 526c, are discussed below since the structure and operation of the cam slot524 and first, second, and third portions 524 a, 524 b, 524 c issubstantially similar thereto.

The first portion 526 a of cam slot 526 is substantially aligned withlongitudinal axis “B-B” defined by end effector 400. The third portion526 c of cam slot 526 extends substantially perpendicularly to thelongitudinal axis “B-B.” The second portion 526 b of cam slot 526 isangled at an obtuse angle with respect to the first portion 526 a (e.g.,the longitudinal axis “B-B”) and the second portions 524 b. Inembodiments, the second portion 526 b is angled at about 45° relative tothe longitudinal axis “B-B.” The first portion of the cam slot extendsat an angle with respect to the second portion and the third portion ofthe cam slot. For example, the first, second, and third portions of thecam slots have a Y-shaped configuration as seen in FIGS. 20 through 24.It is contemplated that the cam slot can have two portions that areangled with respect to one another, or more than three portions that areangled with respect to one another.

As shown in FIG. 6, the end effector 400 may be articulated with respectto the rigid portion 204 of the shaft assembly 200 via the flexibleshaft 202 as well as pivoted with respect to the flexible shaft 202 viathe joint members 502 and 504 about the openings 514 b, 516 b and 523 a,525 a, respectively. The end effector 400 may be pivoted between analigned (e.g., not pivoted) configuration in which the longitudinal axis“B-B” defined by the end effector 400 is aligned with the longitudinalaxis “C-C” defined by the proximal joint member 502, as shown in FIG. 1,and a pivoted configuration in which the longitudinal axis “B-B” isperpendicular to the longitudinal axis “C-C,” as shown in FIG. 6.

The flexible drive shaft 119 allows for operation of the end effector400 regardless of the articulation imparted on the flexible shaft 202.The flexible shaft 202 may be articulated in any desired direction asdescribed above with respect to FIGS. 7-10. The end effector 400 may beactuated (e.g., approximation of the cartridge assembly 432 and theanvil 434 and/or eject the fasteners 433) in either the aligned (e.g.,not pivoted) configuration or the pivoted configuration.

Turning now to FIGS. 16 and 17, operation of the end effector 400 in thealigned configuration, e.g., the joint members 502 and 504 are alignedalong the longitudinal axis “B-B,” is shown and described. In thealigned configuration, the push rod 560 is not engaged by the distalsegment 206, as that would effect articulation of the end effector 400via the joint members 502 and 504, as described below with respect toFIGS. 18-24.

Once the end effector 400 is articulated in a desired position withrespect to the shaft assembly 200, the end effector 400 may be actuatedto clamp and/or seal tissue. To effect actuation, the flexible driveshaft 119 is extended in the distal direction, which in turn, pushes thedrive shaft 530 into engagement with the opening 461 a of the drivescrew 460. The drive shaft 530 moves in a distal direction independentlyof the push rod 560, the spring 562, and the rotation link 564 asdescribed above. Once the drive shaft 530 is engaged with the drivescrew 460, the flexible drive shaft 119 is rotated about thelongitudinal axes “A-A” and/or “C-C” depending on the angle ofarticulation thereof. Rotation of the drive shaft 119 in a clockwisedirection effects rotation of the drive shaft 530 in the same direction,which in turn, rotates the drive screw 460 thereby clamping and/orcompressing tissue between the cartridge assembly 432 and the anvil 434as described above with respect to FIGS. 11 and 12.

Turning now to FIGS. 20-24, the pivoting of the end effector 400 withrespect to the flexible shaft 202 via the joint members 502 and 504about the openings 514 b, 516 b and 523 a, 525 a, respectively, is shownand described.

Initially, as described above with respect to FIGS. 7-10, the distalsegment 206 of flexible shaft 202 is pushed toward the proximal jointmember 502 via tensioning of the cables 205 a, 205 b, 205 c, 205 d,which in turn, pushes the push rod 560 longitudinally in a distaldirection. The push rod 560 engages the clevis 580, which then engagesthe spring 562 thereby biasing the rotation link 564.

Longitudinal movement of clevis 580 longitudinally moves the cam pins582 a, 584 a, through elongate slots 514 a, 516 a of proximal member 502and through first portions 524 a, 526 a of cam slots 524 and 526 of thedistal member 504 as shown in FIGS. 20 and 21. As shown in FIG. 21, thecam pins 582 a, 584 a are longitudinally moved through first portions524 a, 526 a of cam slots 524, 526 until cam pins 582 a, 584 a contactor otherwise operatively engage shoulders between first portions 524 a,526 a and second portions 524 b, 526 b of cam slots 524, 526. Thiscauses the proximal joint member 502 to begin to rotate about theopenings 514 b, 516 b and 523 a, 525 a, as indicated by arrow “P”.

With respect to FIG. 22, upon continued longitudinal movement of campins 582 a, 584 a through elongate slots 514 a, 516 a, cam pins 582 a,584 a enter second portions 524 b, 526 b of cam slots 524, 526 and causeproximal joint member 502 to be in a half-way pivoted configuration.

With respect to FIG. 23, continued longitudinal movement of cam pins 582a, 584 a through elongate slots 514 a, 516 a, moves the cam pins 582 a,584 a from the second portions 524 b, 526 b of cam slots 524, 526 untilthe cam pins 582 a, 584 a contact or otherwise operatively engageshoulders between second portions 524 b, 526 b and third portions 524 c,526 c of cam slots 524, 526. This causes the proximal joint member 502to continue to rotate about the openings 514 b, 516 b and 523 a, 525 a,as indicated by arrow “P”.

As shown in FIG. 24, continued longitudinal movement of cam pins 582 a,584 a through elongate slots 514 a, 516 a, causes the distal portion504, along with the end effector 400, to rotate, about the openings 514b, 516 b and 523 a, 525 a to the pivoted configuration. Continuedlongitudinal movement of cam pins 582 a, 584 a through elongate slots514 a, 516 a, engages the third portions 524 c, 526 c of cam slots 524,526. When applicator end effector 400 has been rotated into the pivotedconfiguration, second portion 524 b, 526 b of cam slots 524, 526 issubstantially axially aligned with the longitudinal axis of elongateslots 514 a, 516 a. Accordingly, with end effector 400 in the pivotedconfiguration, cam pins 582 a, 584 a may move through second portion 524b, 526 b of cam slots 524, 526.

With reference to FIG. 18, once the end effector 400 and the distaljoint member 504 are in the articulated configuration, the rotation link564 is engaged with the end effector 400. In the articulatedconfiguration, the end effector 400 may be rotated about thelongitudinal axis “B-B.” As described above, the push rod 560 is movedin the distal direction to engage the clevis 580 in order to pivot thedistal joint member 504 along with the end effector 400 with respect tothe proximal joint member 502. Distal movement of the push rod 560 alsoengages the spring 562 biasing the rotation link 564, which engages therotation link 564 with the outer engagement member 550. In particular,the gear 569 of the rotation link 564 meshes with the mating surface 550b of the outer engagement member 550.

The drive shaft 530 is mechanically engaged with the rotation link 564via the intermediate portion 570 that provides a complementary matingsurface to the ridge 568, such that rotation of the drive shaft 530, inturn, rotates the rotation link 564. Rotation of the drive shaft 119 ina clockwise direction effects rotation of the 530 in the same direction,which then rotates the rotation link 564. The engagement member 550 isalso rotated since it is coupled to the rotation link 564 and is thentransferred to the engagement portion 411. In particular, the first gear540 a of the engagement member 550 interlocks with the second gear 419 aof the engagement portion 411. Rotation of the engagement portion 411also rotates the end effector 400 about the longitudinal axis “B-B” withrespect to the drive screw 460 since the drive screw 460 is rotatablycoupled to the end effector 400 via the bearings 466.

As shown in FIG. 19, the drive shaft 530 may be advanced in the distaldirection to engage the drive screw 460 to clamp and/or seal tissuebetween the cartridge assembly 432 and the anvil 434 as described abovewith respect to FIGS. 11 and 12. In particular, to effect actuation, theflexible drive shaft 119 is extended in the distal direction. This movesthe drive shaft 530 in the distal direction, disengaging theintermediate portion 570 of the drive shaft 530 from the complementarymating surface of the ridge 568 of the rotation link 564. This allowsthe drive shaft 530 to be rotated within the rotation link 564, suchthat rotation of the drive shaft 530 is used to rotate the drive screw460 to clamp and/or seal tissue between the cartridge assembly 432 andthe anvil 434 rather than rotate the end effector 400 as describedabove.

As the drive shaft 530 is extended in the distal direction, the driveshaft 530 is disengaged from the rotation link 564 and is insteadengaged with the mating surface 552 a of the engagement member 552. Theengagement member 552 is mechanically connected to the engagementportion 415 that is, in turn, coupled to the drive screw 460. Inparticular, the second gear 540 b of the engagement member 552interlocks with the second gear 419 b of the engagement portion 415.

Once the drive shaft 530 is engaged with engagement member 552, theflexible drive shaft 119 is rotated. Rotation of the drive shaft 119 ina clockwise direction effects rotation of the drive shaft 530 in thesame direction, which then rotates the engagement member 552. Rotationof the engagement member 552 is transferred to the engagement portion415, which rotates the drive screw 460 along therewith. Rotation of thedrive screw 460 effectuates clamping and/or compressing of tissue asdescribed above with respect to FIGS. 11 and 12.

The pivoting process may be reversed to return the end effector 400along with the distal joint member 504 into alignment with the proximaljoint member 502. Initially, the rotation link 564 and the drive shaft530 are disengaged from the end effector 400. The flexible drive shaft119 is withdrawn in the proximal direction thereby pulling alongtherewith the drive shaft 530. The bushing 572 is configured anddimensioned to come in contact with the ridge 568 such that as the driveshaft 530 is moved in the proximal direction the rotation link 564 isalso withdrawn therewith. Concurrently or sequentially, the distal jointmember 504 is returned into an aligned configuration. This isaccomplished by retracting the distal segment 206 from the proximaljoint member 502 by loosening the tension of the cables 205 a, 205 b,205 c, 205 d, which then retracts the push rod 560 longitudinally in aproximal direction. The cam pins 582 a, 584 a are moved proximally inorder to return the end effector 400 to the aligned configuration.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, the instrument 100 need notapply staples but rather may apply two part fasteners as is known in theart. Further, the length of the linear row of staples or fasteners maybe modified to meet the requirements of a particular surgical procedure.Thus, the length of a single stroke of the actuation shaft and/or thelength of the linear row of staples and/or fasteners within a disposableloading unit may be varied accordingly. Therefore, the above descriptionshould not be construed as limiting, but merely as exemplifications ofpreferred embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appendedthereto.

1. A surgical device, comprising: a jaw assembly including a first jawand a second jaw moveable relative to the first jaw; a pivoting linkagecoupled to a proximal end of the jaw assembly, the pivoting linkagecomprising a distal joint member and a proximal joint member, the jawassembly and the distal joint member define a first longitudinal axisextending between the proximal end of the jaw assembly and a distal endof the distal joint member, and the proximal joint member defines asecond longitudinal axis; and a camming assembly configured to pivot thejaw assembly relative to the proximal joint member about a pivot axisthat is perpendicular to the first and second longitudinal axes.
 2. Thesurgical device of claim 1, further comprising: a handle assembly; andan elongated body configured to interconnect the handle assembly and thejaw assembly, the elongated body comprising: a flexible shaft coupled toa proximal end of the proximal joint member; and a rigid shaft coupledto the proximal end of the flexible shaft, wherein the rigid shaftdefines a third longitudinal axis and the flexible shaft is configuredto articulate the jaw assembly and the pivoting linkage relative to thethird longitudinal axis of the rigid shaft.
 3. The surgical device ofclaim 1, wherein the distal joint member includes a cam slot defined atthe proximal end of the distal joint member.
 4. The surgical device ofclaim 3, wherein the cam slot includes a first portion, a secondportion, and a third portion, the first portion, second portion andthird portion extending at an angle with respect to one another.
 5. Thesurgical device of claim 3, wherein the cam slot has a Y shapedconfiguration.
 6. The surgical device of claim 3, further comprising amovable clevis having a cam pin disposed within the cam slot.
 7. Thesurgical device of claim 1, wherein the distal joint member comprises apair of opposing cam slots and the proximal joint member includes aclevis having a pair of camming pins disposed within the pair ofopposing cam slots such that the movement of the clevis pivots the jawassembly relative to the proximal joint member about the pivot axis. 8.The surgical device of claim 7, further comprising: a drive screwdisposed within the jaw assembly; and a drive shaft disposed within thepivoting linkage, the drive shaft configured to engage the drive screwand to rotate in a first direction to move the second jaw relative tothe first jaw.
 9. The surgical device of claim 8, further comprising: arotation link disposed within the proximal joint member, the rotationlink defining a lumen therethrough in which the drive shaft is disposed.10. The surgical device of claim 9, wherein the pivoting linkage furthercomprises: a primary gearing assembly comprising: a primary first gearcoupled to the jaw assembly configured to rotate the jaw assembly aboutthe first longitudinal axis; and a primary second gear coupled to thedrive shaft.
 11. The surgical device of claim 10, wherein the pivotinglinkage further comprises: a secondary gearing assembly comprising: asecondary first gear coupled to the primary first gear, the secondaryfirst gear configured to rotate the jaw assembly about the firstlongitudinal axis when the jaw assembly and the distal joint member arein a pivoted configuration; and a secondary gear coupled to the primarysecond gear, the secondary second gear configured to move the second jawrelative to the first jaw.
 12. The surgical device of claim 11, whereinthe rotation link is movable in a distal direction by the clevis and isconfigured to engage the secondary first gear when the jaw assembly andthe distal joint member are in the pivoted configuration.
 13. Thesurgical device of claim 12, wherein the drive shaft is movable betweena proximal position and a distal position and is configured to engagethe rotation link when in the proximal position and to rotate in thefirst direction to rotate the jaw assembly about the first longitudinalaxis when the jaw assembly and the distal joint member are in thepivoted configuration.
 14. The surgical device of claim 13, wherein thedrive shaft is configured to engage the secondary second gear in thedistal position and to rotate in the first direction to move the secondjaw relative to the first jaw.
 15. A surgical device, comprising: a jawassembly including a first jaw and a second jaw movable relative to thefirst jaw; a pivoting linkage coupled to a proximal end of the jawassembly, the pivoting linkage comprising a distal joint member and aproximal joint member, the jaw assembly and the distal joint memberdefine a first longitudinal axis extending between the proximal end ofthe jaw assembly and a distal end of the distal joint member, and theproximal joint member defines a second longitudinal axis, the jawassembly being pivotable relative to the proximal joint member about apivot axis that is perpendicular to the first and second longitudinalaxis; and a flexible shaft proximal of the pivoting linkage, theflexible portion having a plurality of openings accommodating aplurality of cables for effectuating the flexible portion.
 16. Thesurgical device of claim 15, wherein the flexible shaft includes aplurality of segments, each segment having a ball joint at a distal endthereof, and a proximal end defining a socket.
 17. The surgical deviceof claim 16, wherein the distal joint member includes a cam slot definedat the proximal end of the distal joint member.
 18. The surgical deviceof claim 17, wherein the cam slot includes a first portion, a secondportion, and a third portion, the first portion, second portion andthird portion extending at an angle with respect to one another.
 19. Thesurgical device of claim 17, wherein the cam slot has a Y shapedconfiguration.
 20. The surgical device of claim 17, further comprising amovable clevis having a cam pin disposed within the cam slot.